Communication about colorectal cancer screening in Britain: public preferences for an expert recommendation.

BACKGROUND: Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. METHODS: In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50-80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. RESULTS: Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. CONCLUSION: Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An 'expert' view may be an important part of autonomous health decision-making.

Influence of soybean hull supplementation on rumen fermentation and digestibility in steers consuming freshly clipped, endophyte-infected tall fescue.

Six steers (288.6 +/- 2.1 kg of BW) fitted with rumen and duodenal cannulas were used in a crossover design to evaluate intake, rumen fermentation, and site of nutrient digestion of freshly clipped, endophyte-infected (E+) Kentucky 31 tall fescue with or without soybean hull (SH) supplementation at 0.60% of BW (OM basis). Steers were placed in metabolism units within an environmentally controlled room and provided with free-choice access to fresh forage, water, and a vitamin/mineral supplement. The spring growth of E+ tall fescue was harvested daily during the experiment. Supplement was fed at 0700 with approximately 65% of the estimated daily forage. To maintain a fresh forage supply, additional forage was stored in a cooler and fed at 1900. Periods were 21 d with 14 d of adaptation and 7 d of digesta sample collection. Chromic oxide was used as a marker of duodenal digesta flow. Duodenal samples were taken 4 times daily with times shifting by 1 h each day to represent all 24 h of a day. Treatments were considered significant at P < 0.05. Supplementation of SH decreased forage OM intake from 1.64 to 1.41% of BW but increased total OM intake from 1.64 to 2.01% of BW. Apparent percentages (53.1%) and quantities (2,786 g/d) of rumen OM disappearance were not affected by supplementation. Percentages of total tract OM disappearance were not different (70.8%). Percentages of apparent rumen NDF disappearance also were not different (65.6%). Percentages of N disappearance were not different. Supplementation of SH resulted in increased total N (34.1 g/d) and microbial N (17.1 g/d) flowing to the duodenum. Rumen pH (6.5) was not affected, and rumen ammonia concentrations exhibited a time x treatment interaction in which SH decreased ammonia for 12 h after supplementation. Total VFA concentrations (103.9 mM) were unaffected. Liquid dilution rate (12.7%/h) and rumen OM fill (4.3 kg) were not different between treatments. Supplementation of SH at a rate of 0.60% of BW (OM basis) to calves consuming fresh E+ tall fescue decreased forage consumption but resulted in greater total intake, greater flow of N to the duodenum, and increased total tract OM disappearance.

Chronic exposure to typical or atypical antipsychotics in rodents: temporal effects on central alpha7 nicotinic acetylcholine receptors.

A decrease in alpha7 nicotinic acetylcholine receptors in the hippocampus has been hypothesized to contribute to alterations in auditory gating and other behavioral impairments in schizophrenia. However, while both typical and atypical neuroleptics are routinely used in the therapeutics of schizophrenia, little is known about their effects on auditory gating or alpha7 nicotinic acetylcholine receptor expression particularly when they are administered for extended periods of time (which is common in the clinical setting). In the present study in normal rats, the residual effects of prior chronic treatment (90 or 180 days) with representative typical and atypical neuroleptics (oral haloperidol, 2.0 mg/kg/day; chlorpromazine, 10.0 mg/kg/day, risperidone, 2.5 mg/kg/day; or olanzapine, 10.0 mg/kg/day) on prepulse inhibition of the auditory gating response were investigated. The densities of alpha7 nicotinic acetylcholine receptors were subsequently measured using [125I]-alpha-bungarotoxin autoradiography. The results indicated that none of the compounds significantly altered the startle amplitude or prepulse inhibition response either during drug treatment (day 60) or after 90 or 180 days of treatment (i.e. during a drug free washout). However, prior exposure to chlorpromazine, risperidone and olanzapine for 90 days resulted in modest but significant (P<0.01) decreases in [125I]-alpha-bungarotoxin binding sites in some brain regions (e.g. posterior cortical amygdala). After 180 days of treatment, decreases in [(125I]-alpha-bungarotoxin binding ranging from approximately 12% (lateral dentate gyrus) up to 24% (e.g. CA1 hippocampal region) were evident in the risperidone group in 13 of the 36 regions analyzed while decreases associated with the other neuroleptics agents were still present, but not statistically significant. These data indicate that the commonly used atypical neuroleptic, risperidone is associated with time dependent and persistent negative effects on an important biological substrate of memory (i.e. the alpha7 nicotinic receptor), but that the magnitude of the deficits was not sufficient to impair auditory gating.

Enhancing alpha-tocopherol and linoleic acid in ewe's milk by feeding emulsified sunflower oil and DL-alpha-tocopheryl acetate in a chemically treated protein matrix.

Chemically treated dietary supplements (CTDS) were prepared with defatted soy flour, sunflower oil, dl-alpha-tocopheryl acetate (TA), and 2,3-butanedione (a generally recognized as safe chemical), and the effects on alpha-tocopherol (VE) concentration and fatty acid profile in ewe's milk were estimated. Ewes fed control diet (CD) had the lowest levels of milk VE (0.66 microg/mL) and serum VE (1.59 microg/mL). Feeding ewes the CD plus 500 IU of TA increased milk and serum VE by 30 and 70%, respectively, compared to ewes fed the CD. The CTDS-fed ewes showed further increased milk and serum VE levels by 40 and 32%, respectively, over those in ewes fed the CD plus 500 IU of TA. Feeding ewes CTDS did not affect milk fat content (3.13%) but altered the fatty acid composition by decreasing the levels of hypercholesteremic fatty acids, while increasing the content of linoleic acid (8.5%). Inclusion of CTDS in ruminant diets might produce nutritionally enhanced milk products.

Plaque fluoride concentrations in a community without water fluoridation: effects of calcium and use of a fluoride or placebo dentifrice.

The results of a recent study by Whitford et al. [Caries Res 2002;36:256-265] with subjects whose drinking water was fluoridated led to two major conclusions: (1) Compared to the use of a placebo dentifrice, plaque fluoride concentrations ([F]) throughout much of the day are not significantly increased by the use of an F dentifrice but (2) they are positively related to plaque [Ca] (p = 0.0001). The present double-blind, double-crossover study with 16 subjects used the same protocol and was done to: (1) determine the effects of the use of an F dentifrice on salivary and plaque [F] in a community without water fluoridation and (2) further examine the relationship between plaque [Ca] and [F]. Following the use of an F dentifrice or placebo for one week, whole saliva and plaque were collected 1.0 and 12 h after the last use of the products. The study was repeated to include rinsing with a 20 mmol/l CaCl(2) solution immediately before the use of the dentifrices. The CaCl(2) rinse had only minor effects on salivary [Ca] and [F] and none on the plaque concentrations. Unlike the results found in the fluoridated community, all salivary and plaque [F] associated with the use of the F dentifrice were significantly higher than those associated with the use of the placebo. The results suggest that the cariostatic effectiveness of an F dentifrice should be greater in areas without water fluoridation. As noted previously, plaque [F] were positively related to plaque [Ca] (p = 0.0001).

Feeding encapsulated ground full-fat soybeans to increase polyunsaturated fat concentrations and effects on flavor volatiles in fresh lamb.

This research assessed the potential of increasing PUFA concentrations and the effect on flavor volatiles in red meat by feeding ground, full-fat soybean supplemented in casein complex. Supplements consisted of untreated ground, full-fat soybean (CO) or ground, full-fat soybeans treated with acetaldehyde (AC) or diacetyl (DA) to form gels. On a DM basis, the control (CO), AC, and DA supplements contained 48.6, 50.0, and 49.1% CP and 17.3, 17.3, and 17.4% fat, respectively. Weaned feeder lambs (n = 18) were divided into three treatment groups with two pens of three lambs per group. One of three supplements (200 g of DM) plus 1 kg DM of a ground corn basal diet and 0.36 kg DM of grass hay was fed daily to each of six lambs in a group for 9 wk. Samples of the intramuscular (LM), intermuscular, subcutaneous, and kidney fat were obtained from each lamb carcass for determination of total lipid contents and fatty acid profiles. Flavor volatiles of broiled LM were also analyzed. Total fat content of the LM was 3.7, 4.6, and 2.6% for lambs consuming diets supplemented with CO, AC, and DA, respectively. Compared with lambs fed the untreated supplement (CO), lambs supplemented with AC or DA had 1) higher (P < 0.05) concentrations of linoleic (4.80 vs. 6.37 or 6.80%) and linolenic (0.28 vs. 0.43 or 0.45%) acids in the LM nonpolar lipids; 2) a higher (P < 0.05) concentration of linoleic acid (22.1 vs. 27.1 or 25.6%), but a lower (P < 0.05) concentration of oleic acid (17.2 vs. 13.0 or 13.1%), in the LM polar lipids; 3) a higher (P < 0.05) concentration of linoleic acid (3.77 vs. 6.13 or 6.06%) in subcutaneous fat; and 4) higher (P < 0.05) concentrations of linoleic (4.46 vs. 7.65 or 7.13%), linolenic (0.50 vs. 0.85 or 0.80%), and stearic (24.9 vs. 27.2 or 26.9%) acids, but a lower (P < 0.05) concentration of oleic acid (39.1 vs. 35.4 or 36.3%), in kidney fat. In broiled LM chops, 21 volatiles were identified, including seven alkanals, seven 2-alkenals, two 2,4-alkadienals, and five other compounds, but most differences in the volatile concentrations among lambs fed the different supplements did not correspond to concentration differences in their precursor fatty acids. Results indicated that compared with the untreated supplement (CO), AC and DA supplements protected linoleic (C 18:2n6) and linolenic (C18:3n3) acids in soybean oil from degradation in the rumen of the lambs, resulting in increased deposition in the muscle and adipose tissues of lamb.

A scheme for describing injury events.

OBJECTIVE: To develop a data collection system that provides a more comprehensive picture of the components of the preinjury and injury phases of injury events than is usually available in medical records. METHOD: Based on a scheme originally designed for study of occupational injuries among off-shore petroleum drilling workers, eight data areas were designated and lists of categories were developed to permit applicability to a general injury surveillance program. Medical records for 1600 injured patients treated at the Medical Center Hospital of Vermont were reviewed to determine current frequency of recording such information. RESULTS: A scheme for injury surveillance was designed that included location of the event, general and specific activities at time of injury, work relationship, nature of the event, animal or person contact, products or materials being used and those causing injury, and energy type and mechanism. CONCLUSION: An acceptable scheme has been developed that can be used for general surveillance, or modified to focus in greater detail on specific environments, products, or event types.

Is colonoscopic screening appropriate in asymptomatic patients with family history of colon cancer?

Colonoscopy has been advocated by some investigators as the most appropriate means of screening asymptomatic patients with a positive family history of colorectal cancer. However, results of such screening have been widely disparate. The purpose of this study was to evaluate the yield of colonoscopy in a cohort of completely asymptomatic individuals with one or two first-degree relatives with a history of colorectal cancer and to compare this yield with that of colonoscopy in a group of patients with apparent anal bleeding. Patients with possible genetic disorders, such as familial polyposis, were excluded. A total of 160 asymptomatic patients and a comparison group of 137 patients with nonacute anorectal bleeding underwent colonoscopy. Colonoscopy was completed in 143 of the 160 study patients (89 percent) and in all of the comparison patients and did not result in any complications. Twenty-two adenomas were found in 17 study patients (10.6 percent); 16 of the 22 adenomas were less than 1 cm in size. In the comparison group, eight adenomas were identified (5.8 percent of patients). No cancers were identified. The difference in polyp frequency between groups was not significant. The relatively low yield of colorectal neoplasms discovered at colonoscopy in this study may in part be due to the small sample size or to the strict criteria used to define these asymptomatic patients but does not lend strong support to the notion that colonoscopy is an appropriate first step in screening the asymptomatic patient with one or two first-degree relatives with colon cancer.

Use of avidin to prepare biotin-free culture media.

Dialysis of avidin-treated casein hydrolysate and peptone solutions produced biotin-free dialysates which, when incorporated into growth media resulted in media devoid of biotin. Wright-Skeggs medium supplemented with dialyzed, avidin-treated, casein hydrolysate did not support significant growth of Bacillus coagulans or Lactobacillus plantarum without biotin supplementation. Eagle's minimal essential medium supplemented with avidin-treated, peptone dialysate (MEMAPD) would not support the growth of LM strain mouse cells through more than a single passage without biotin supplementation. MEMAPD supplemented with biotin supported good growth of the LM cells through repeated passages. Using this medium it was possible to demonstrate that LM cells require biotin for growth and that they cannot utilize avidin-complexed biotin. Avidin treatment of peptone or casein hydrolysate solutions allowed accurate control of the biotin content in culture media and did not remove significant amounts of substances other than biotin. By comparison, activated charcoal nonspecifically removes biotin as well as other essential nutrients and adds unknown substances to the medium which interfere with the growth of tissue culture cells.

Hemodynamic changes during fentanyl--oxygen anesthesia for aortocoronary bypass operation.

Fentanyl in doses of 50-60 microgram/kg has been reported to produce anesthesia with remarkable hemodynamic stability in patients with coronary artery disease (CAD). Because the authors had observed hypertension and tachycardia in response to noxious stimulation during aortocoronary bypass (ACB) operations in patients so anesthetized, they studied the hemodynamic changes and anesthetic conditions produced by fentanyl/O2/relaxant anesthesia in patients undergoing elective ACB. Twelve patients with left ventricular (LV) ejection fractions greater than 0.4 were maintained on propranolol until 10 hours before operation and were premedicated with fentanyl, diazepam, and scopolamine. Cannulae were inserted before the study commenced for measurement of intravascular pressures, arterial blood gases, and thermodilution cardiac output. The patients breathed 100 per cent oxygen throughout the study. Controlled ventilation aided by succinylcholine to reduce truncal rigidity maintained PaCO2 at 30-45 torr. Measurements were made after each of the following: breathing oxygen (control), 10 microgram/kg fentanyl, 50 microgram/kg fentanyl, and 0.1 mg/kg pancuronium, tracheal intubation, skin incision, and sternotomy. Fentanyl alone produced no significant hemodynamic changes. Fentanyl and pancuronium in combination produced increased heart rate and reduced stroke volume. Significant and progressively greater increases in mean arterial pressure and systemic vascular resistance followed intubation, skin incision, and sternotomy. Chest rigidity occurred in every patient at a lower fentanyl dose than did unresponsiveness. While fentanyl, 62.4 +/- 2.9 microgram/kg (SE), produced minor hemodynamic changes, it failed to block hemodynamic responses to noxious stimulation. Such changes resulted in increased cardiac work, and could have affected myocardial oxygen balance unfavorably. In eight of the 12 patients, following the last set of measurements, supplementary anesthetic agents were required to maintain hemodynamic stability during the surgical procedure. The authors suggest that this fentanyl/O2/relaxant technique should be modified for patients with severe CAD and reasonably good LV function.